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Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT.

Publication ,  Journal Article
Sood, N; Ruwald, A-CH; Solomon, S; Daubert, JP; McNitt, S; Polonsky, B; Jons, C; Clyne, CA; Zareba, W; Moss, AJ
Published in: Eur Heart J
January 2014

OBJECTIVE: The aim of the present study was to assess a possible association between myocardial substrate, implantable cardioverter defibrillator (ICD) shocks, and subsequent mortality. METHODS: Within the multicentre automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT) population (n = 1790), we investigated the association between myocardial substrate, ICD shocks and subsequent mortality using multivariate Cox regression analyses and landmark analyses at 1-year follow-up. RESULTS: The 4-year cumulative probability of ICD shocks was 13% for appropriate shock and 6% for inappropriate shock. Compared with patients who never received ICD therapy, patients who received appropriate shock had an increased risk of mortality [HR = 2.3 (1.47-3.54), P < 0.001], which remained increased after adjusting for echocardiographic remodelling at 1 year (HR = 2.8, P = 0.001). Appropriate anti-tachycardia pacing (ATP) only was not associated with increased mortality (P = 0.42). We were not able to show an association between inappropriate shocks (P = 0.53), or inappropriate ATP (P = 0.10) and increased mortality. Advanced myocardial structural disease, i.e. higher baseline echocardiographic volumes and lack of remodelling at 1 year, was present in patients who received appropriate shocks but not in patients who received inappropriate shocks or no shocks. CONCLUSION: In the MADIT-CRT study, receiving appropriate ICD shocks was associated with an increased risk of subsequent mortality. This association was not evident for appropriate ATP only. These findings, along with advanced cardiac structural disease in the patients who received appropriate shocks, suggest that the compromised myocardium is a contributing factor to the increased mortality associated with appropriate ICD shock therapy. Clinical trials.gov identifier: NCT00180271.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

January 2014

Volume

35

Issue

2

Start / End Page

106 / 115

Location

England

Related Subject Headings

  • Tachycardia
  • Stroke Volume
  • Risk Factors
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Injuries
  • Heart Failure
  • Female
 

Citation

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Sood, N., Ruwald, A.-C., Solomon, S., Daubert, J. P., McNitt, S., Polonsky, B., … Moss, A. J. (2014). Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT. Eur Heart J, 35(2), 106–115. https://doi.org/10.1093/eurheartj/eht451
Sood, Nitesh, Anne-Christine H. Ruwald, Scott Solomon, James P. Daubert, Scott McNitt, Bronislava Polonsky, Christian Jons, Christopher A. Clyne, Wojciech Zareba, and Arthur J. Moss. “Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT.Eur Heart J 35, no. 2 (January 2014): 106–15. https://doi.org/10.1093/eurheartj/eht451.
Sood N, Ruwald A-CH, Solomon S, Daubert JP, McNitt S, Polonsky B, et al. Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT. Eur Heart J. 2014 Jan;35(2):106–15.
Sood, Nitesh, et al. “Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT.Eur Heart J, vol. 35, no. 2, Jan. 2014, pp. 106–15. Pubmed, doi:10.1093/eurheartj/eht451.
Sood N, Ruwald A-CH, Solomon S, Daubert JP, McNitt S, Polonsky B, Jons C, Clyne CA, Zareba W, Moss AJ. Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT. Eur Heart J. 2014 Jan;35(2):106–115.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

January 2014

Volume

35

Issue

2

Start / End Page

106 / 115

Location

England

Related Subject Headings

  • Tachycardia
  • Stroke Volume
  • Risk Factors
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Injuries
  • Heart Failure
  • Female